Ever get a bruised knee bone from doing a long hike?

[Roleigh Martin]

I did fine on my 2012 3rd full-thru JMT hike for the first 16 days of hiking but on the 17th and 26th day of hiking the ordinary schedule is to do about 4-5 miles uphill then 10-11 miles downhill (with the downhill being about 3800 and 6000 feet of descent (respectively descending from Muir Pass and Mt Whitney (the tallest mountain in the 48 contiguous states)). Each of these two days, my left knee became inflamed and I ended up favoring the right knee to the point it became sore too. After the Muir Pass descent, the knee quickly recovered in about 5-6 days (I was hiking with a limp though), but after Whitney (which was the final exit day of the full JMT trail), my knees were so sore, that 12 days later (today), I'm still sore (not as much when not using the knee) and slowly handle stairs and walk a little slowly.

I should have taken two days apiece to do each long descent and I'd have been in much better shape now (perhaps not have the problem at all). I did not have this problem prior to the torn knee meniscus issue (which I've reported on earlier at link and which happened July 2, 2011), so I know that the prolotherapy sessions have not healed my knee 100% fully. I need to continue the treatments and will. I hope I did not worsen my knees because of those two days (particularly the last day). I feel like I am only about 2.5% better each day so I know it will be probably 1-2 months before I know the full impact. I was told that prolotherapy treatment for older people (I'm 62) can be up to 6-9 sessions. I have had 3 stem cell prolotherapy treatments and 3 standard prolotherapy treatments. I am going to continue my treatments but have switched clinics to one locally in Avon, CT. A Dr. Paul Tortland — I think he is as good as the provider who did the stem cell treatment from Chicago.

I feel like daily I'm getting about 2-3% better so I think in 1-2 months, I'll be back to normal. I wondered what had happened to me and after some Google Research feel I suffered a non-surface visible knee bone bruise. I found some interesting links on this:

http://www.wisegeek.com/what-are-the-symptoms-of-a-bone-bruise.htm (Link.)
"Sometimes the bruise is visible on the skin when other soft tissues are bruised, but the only definitive way to determine if swelling is the result of a bone bruise is with an X-ray. "

http://www.livestrong.com/article/24790-bruised-bone/ (Link.)
http://www.livestrong.com/article/84542-treat-deep-bone-bruise-knee/ (Link.)
http://www.livestrong.com/article/423506-physical-therapy-for-a-bruised-knee-bone/ (Link.)

http://tinyurl.com/9gqtw4l (Link. )
"Magnetic resonance imaging of 1546 patients revealed bone bruises in 19% of patients without an associated meniscal or ligamentous injury. For those patients presenting with at least one meniscoligamentous injury, the frequency of bruising was 60% at 0 to 4 weeks, 42% at 4 to 10 weeks, and 31% at 10 to 26 weeks postinjury."

http://www.ajronline.org/content/189/3/556.full (Link.)
"RESULTS. In 80 patients, 157 bone bruises were found. The estimated median healing time was 42.1 weeks. Healing was prolonged in patients having a higher number of bone bruises and in the presence of osteoarthritis. Resolution of individual bone bruises was prolonged in the presence of osteoarthritis and greater age. Reticular lesions were less likely to be present after 6 months than other bone bruise types."

http://www.livestrong.com/article/538956-how-to-recover-from-a-knee-bone-bruise-after-running/ (Link.)

I'm going to be contacting Dr. Tortland shortly.

I'll update this posting after seeing him.

I am wondering if others have had a similar problem. I plan on doing a JMT in 2013 again (my 6th but 4th planned full thru-hike of the JMT) but am currently planning on doing the distance I did in one day apiece for the Muir Pass and Trail Crest Pass descents into two days apiece so that I do not have such long continuous downhill descents in one day.

Thanks in advance!

[Bob Bankhead]

Never.

Downhill is always easy for me. It's that @#$% uphill (PCT = Perpetually Climbing Trail; JMT = Just for Mules Trail) that gets to me.

[Paul Wagner]

How old are you? I have mild arthritis in both knees. And it hurts when I do too much downhill. Advil and hiking poles both seem to help.

[Roleigh Martin]

I'm 62.

[Bob Gross]

First, you don't mention what kind of a load you were carrying for the days when the pain developed. You might need to reduce that load by 40% to get by. Do a trade. Offer to carry some extra load for somebody uphill if they will carry the equal weight downhill for you.

I read this about older hikers, but you are only 62. (Just a kid)

On my first trek in Nepal, a wise Sherpa taught me how to walk downhill like a Sherpa. That works. It slows you down a little bit, but if that is what it takes to prevent sore knees, then so be it.

–B.G.–

[Roleigh Martin]

Bob,

Thanks. Can you please go into detail, carefully describing how to walk downhill like a Sherpa.

Thanks!

Roleigh

[Roleigh Martin]

I've posted the above trip report problem elsewhere. Another hiker said he had a similar problem until he started walking according to the advice given in Chi Walking. Link

Also at the Chi Walking home page. Link

Anyone know firsthand about Chi Walking?

I've ordered their 3 CD audiobook item and DVD at Amazon. (see top link above).

Thanks in advance.

Roleigh

[Roleigh Martin]

Bob,

I found a posting of yours that does a descent description. If you care to elaborate please do. Here is your earlier posting:

"Re: Walking Technique? on 03/19/2011 12:52:18 MDT

This does not apply to flat land, but for steep downhills.

When trekking in Nepal, many of the other trekkers were getting "sahib's knee." It seemed to be very painful and most of the knees were swollen. Typical impatient Americans were trying to walk downhill too fast with their knees fully extended at the time of heel impact. As a result, the impact force was transmitted directly through the knee joint.

The Sherpa mountain guides showed them how to "walk like a Sherpa" to ease the situation. First, you have to lower your center of gravity slightly by flexing your knees. Second, you walk slightly bowlegged. That spreads your weight out to the sides more so that you don't fall. Third, you take shorter and quicker strides. The result is that there is less impact force through the knee joint, and instead the force is carried by your quadriceps muscles. You have to practice it a bit in advance. Once you get good at it, you can vary the intensity of this stride and use it comfortably.

–B.G.–"

[Bob Gross]

"how to walk downhill like a Sherpa"

First, understand that the average American hiker goes downhill with a long stride, and when the heel strikes, the leg is fully extended (straight). This means that the force of the heel strike is transmitted directly up through the leg, and it caused the impact to be absorbed in the soft parts of the knee. This is the basic problem.

1. Walk slightly bowlegged, or with a wider stance. This gives you slightly better side-to-side balance.
2. Lower your center of gravity slightly by flexing your knees slightly (not straight). This forces the impact to be absorbed more in your quadriceps. Well, leg muscles will get a little tired, but they don't swell up like knee joints.
3. Instead of taking long, methodical strides, you take quicker strides that are much shorter. It looks like you are almost skipping down the trail.
4. You have to practice this a little before it will become automatic. You need to get to where you can "slip into it" gradually and only to the degree that is necessary for that slope, and then you slip back to normal.
5. At first, you will be a little slower with this walking method. Later when it is fully automatic, there won't be much speed lost.

This was taught to me by a wise old Sherpa in 1983, and when I saw him again in 1997, he was still on the trail.

–B.G.–

[Mike In Socal]

Hi Roleigh,

Both my daughters run about 50-60 miles per week for their high school cross country teams. They (and I) try to do ice baths for recovery and it might help you recover faster as well. Runners World has an article on the benefits here:

http://www.runnersworld.com/article/0,7120,s6-241-285–12810-0,00.html

Hope that helps.

Mike

[Roleigh Martin]

Bob, I forgot to answer your question. My base load was 20 lbs (way too much, it should have been 16 lbs). With food and water, typical weight was about 26 lbs. Base included the 2 lb 5 oz bearikade expedition bear canister and pack weight.

I think I had too much stuff in my first aid, toiletry, and gear ditty bags.

I don't think it was the base load that did the problem. I reduced my carry-load by 35 pounds over 2009 (because I lost 35 pounds of weight between Oct 2011 and July 2012 due to Intermittent Fasting–I am now at a proper body weight, 161 lbs).

(I have lots of cool links on Intermittent Fasting — click on my Google Profile at my BPL profile page)

Roleigh

[Bob Gross]

"I don't think it was the base load that did the problem."

If your base load was 20, and the load with food and water was only 26, then the load problem was obviously in the base load. Only 6 pounds of food and water is tiny. Along the JMT, there isn't much need for it to be over 10.

–B.G.–

[Roleigh Martin]

I think the problem was (a) my left knee was not fully healed to pre-injury (July 2 2011) state of health and (b) because of "a", not taking 2 days to do the long downhill descents.

[Greg Mihalik]

Roleigh,
It is not uncommon for folks to have a leg strength deficiency that results in "falling" the final inch or two when descending stairs, curbs, etc. It's easy to miss and in everyday city life has little consequence. On a long downhill trail it can lead to countless jarring bumps that will eventually take their toll.

You can test yourself the next time you have some descending steps, with a handrail, by trying to halt your leading heel 1/4" above the tread, then completing the step down in full control. And ideally, you should be able to reverse your progress until your hips are level. (Well, You can't until you are put back together again.)

[Bob Gross]

"my left knee was not fully healed to pre-injury"

Decades ago, a wise physical therapist demanded that I continue doing my exercises to restore my knee, and that had to continue until the problem knee was stronger than the normal knee. Only then was I allowed to return to my sport. Then, after a period of time, the two knees will balance out a bit. In contrast, if you restart your sport when the problem knee is still on the mend, the normal knee is stronger, so it carries more than its share of the load. The result of that is that the normal knee gets stronger and the problem knee stays only half-strong.

–B.G.–

[Roleigh Martin]

Bob, your wise therapist has great advice. My problem was that I thought my knee was pre-injury healed, it took 17 days on the JMT to realize it wasn't and only then when it was doing greater than 10 miles of downhill in a single day.

I'll continue treatment and exercises and therapy on the knee another year, and next year on the JMT, I'll split those 2 days on the JMT (south side of Muir Pass, and exiting from Whitney) into 4 days to play it safe.

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